Provider Demographics
NPI:1528545357
Name:TIEDEMAN, JONATHAN ALVIN (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ALVIN
Last Name:TIEDEMAN
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:91 MERCEDES LN
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-4617
Mailing Address - Country:US
Mailing Address - Phone:925-625-0700
Mailing Address - Fax:925-625-1863
Practice Address - Street 1:100 SIMONI RANCH RD
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-2787
Practice Address - Country:US
Practice Address - Phone:925-625-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool